Ambcoach –Contact us about Billing Related Services for Ambulance, EMS, Medical Transport organizations

Patient Inquiry Form

(You will need the invoice you received to complete this form)

* Patient Name:

Address:

* City:

* State:

Zip:

Phone:

* Email:

Please look at the top of your invoice and enter the following information.

Ambulance Service Name:

Patient #:

Call #:

Date of Service:

Membership or Subscription with the Ambulance Service permits third party insurance billing. Please review the message at the bottom of your invoice. This message will advise you of the status of your account. We look forward to hearing from you regarding your account and will be happy to answer your questions.

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